People who lose at least ten per cent of their body weight are more likely to achieve type 2 diabetes remission even if they have lived with it for an extended period and have advanced disease and complications, a new study has found.

Notably, losing at least 10% of body weight was associated with a 53% higher chance of achieving remission than losing less weight. 

The study, “Association between weight change and remission of type 2 diabetes: a retrospective cohort study in primary care,” was published in Practical Diabetes.

Diabetes remission is defined as achieving a glycated haemoglobin (HbA1_c) level below 48 mmol/mol or 6.5% without medication or undergoing surgery. 

Previous clinical trials show that people with type 2 diabetes can achieve remission with intensive diet, exercise and behavioural-change counselling programmes. However, many of these trials have used very-low-calorie diets (usually meal replacement plans) with moderate to intense exercise programmes to achieve these results.

Moreover, these studies have lasted for six months or less and only show the short-term effects of weight loss. They’ve also only typically included people at the early stages of the disease. 

Very few studies have evaluated whether achieving remission through weight loss is a realistic target for the general population with different stages of type 2 diabetes who do not follow low calorie diets and strict exercise programmes.

A team of scientists in the United Kingdom now analysed data from a large cohort of people with type 2 diabetes registered across 150 primary care practices in Southern England to investigate the link between weight change and the likelihood of achieving remission. All participants records included demographic information and weight, body mass index (BMI), blood pressure, HbA1c, total cholesterol, HDL cholesterol and kidney function measurements.   

A total of 56 120 people with type 2 diabetes were included in the study. Participants were primarily White (96.2%), 2.7% were Asian, and 0.4% were Black. The mean age of the cohort was 63 years, with a mean BMI of 31. The majority (57%) were male and lived with type 2 diabetes for an average of eight years. 

Many participants (19%) had macrovascular (affecting large blood vessels) complications, including stroke, myocardial infarction, or amputations. And 30.4% had microvascular (affecting small blood vessels) complications, including nerve damage, eye and kidney disease. All participants were followed for an average of 6.8 years. 

Within five years of the study, 22.4% maintained their weight, 8.3% gained over 10% of their body weight and 19% lost at least 10% of their body weight. Of those who lost at least 10% of their body weight, 15.1% achieved remission. Interestingly, a weight loss of at least 10% of body weight was associated with a 53% higher chance of achieving remission.

In total, 11.7% of participants achieved remission. These participants were older, had diabetes for a shorter period (less than five years), were female, had fewer co-occurring conditions and were more likely to live in the least deprived areas. 

“In this population-based cohort of 56,120 people with type 2 diabetes, weight loss of more than 10% over five years significantly increased the likelihood of achieving remission. These findings were observed in a cohort of people with type 2 diabetes in the community without intensive intervention who were followed up through routine primary care,” the researchers wrote. 

“Many were able to achieve remission even among those with diabetes for many years (average duration of 8.0 years), with [co-existing conditions]…and complications,” they wrote. 

Notably, these findings may not apply to people with other types of diabetes such as monogenic or autoimmune diabetes. 

Still these results show that remission is a realistic target for people who can achieve significant loss gradually even if they lived with type 2 diabetes for many years and have complications. 

“[Remission] is achievable in the absence of intensive intervention but will be influenced by sociodemographic and clinical factors,” the researchers concluded.